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Advanced Training in Anaesthesia for Major Surgery

University Hospital of North Durham

Contact:   Dr Alistair Duggie, College Tutor

 

Domain 1-Clinical Practice

At UHND, we perform over 200 major intra-abdominal operations a year, which include both open and laparoscopic work.  These are largely for cancer (120+), inflammatory bowel (40+) and other pathology (40+). In addition, there are a small number of these that are combined cases with plastics (about 5-10/year) which require free flaps. All patients undergoing major abdominal surgery are seen in a high risk anaesthetic clinic (4/week) with cardiopulmonary exercise testing routinely performed as part of the preoperative assessment.

Domain 2-Team working

There are regular colorectal and Vascular MDTs every week at UHND. During the patient pathway, there are multiple opportunities to enhance their team working skills, which include but are not limited to participating in MDTs, Preoperative Assessment, Acute pain ward rounds. Trainees in the advanced module will also be in the second tier on call rota where they have further opportunities to develop their team working skills.

Domain 3- Leadership

At UHND, there is good precedent of senior trainees leading on patient care starting from the preoperative assessment all the way to postoperative care. Trainees towards the end of their training have also been given the opportunity to act up and work at Consultant level.

Domain 4-Innovation

There are opportunities to participate and lead on patient improvement initiatives in Preoperative Assessment.

There are regular portfolio research projects running in UHND and trainees can choose to get involved in varying degrees to get a better understanding of conducting research in the NHS.

Domain 5-Management

We have an agreement with the Care group director and Medical director to allow the candidates to shadow them during appropriate meetings/events.  This will give the candidate an insight into higher level  management styles and leadership skills.

Domain 6-Education

There is a year round teaching programme for covering all the common exam topics. We get a regular intake of undergraduate students who have their own teaching programme as well. We also have regular teaching sessions for the nursing staff across various groups which include recovery and preoperative nurses. Candidates can choose to organise and deliver these teaching sessions to develop this aspect of their training.

James Cook University Hospital

Pre-assessment and Peri-operative Medicine

Module Supervisor:  Dr Matt Cheesman

 

An exciting opportunity is available for trainees within the department of Anaesthesia at South Tees Hospitals NHS Foundation Trust.  In collaboration with the Northern School of Anaesthesia we have created advanced training positions combining clinical work in the Pre-assessment clinic, Major surgery in theatre and access to relevant aspects of peri-operative Medicine.

The intention of this attachment is to provide a year of clinical training that can be mapped to the RCOA advanced curriculum and the opportunity to participate in research/academic projects as a senior trainee. The post is designed to incorporate teaching and solo lists in complex major surgeries, pre-assessment and commitment to out-of-hours service provision in a Major Trauma Centre.  There will also be timetabled opportunities to access research/academic activities and relevant aspects of peri-operative Medical care.

Clinical training

The year is divided into 4 blocks of 3 months designed to fulfil the core learning outcomes for Advanced training with in built pre-assessment sessions to enable the individual to gain experience in both pre-assessment clinic and CPEX.  In the table below we have suggested the blocks that we feel are likely to “best fit” with pre-assessment and peri-operative Medicine, however it should be noted that any of the subspecialties in the General Duties module (such as Obstetrics if desired) can be accommodated.  Successful candidates will:

  1. Deliver anaesthesia and pre-assessment sessions involving a wide range of surgical cases demonstrating understanding of the problems encountered
  2. Show the decision making and organisational skills required of an anaesthetist to manage busy clinics and operating sessions that involve major surgery and ensure the care that is delivered is safe and timely
  3. Assist colleagues in decisions about the suitability of surgery in difficult situations
  4. Provide teaching to less experienced colleagues of all grades
Suggested Blocks Case Mix Specific Module Learning outcomes
Vascular Surgery with vPAC & CPET EVARs, Carotid surgery, Open aneurysm surgery, peripheral revascularisation procedures.  Opportunities to attend vascular PAC. WBAs as per 2010 curriculum (1x A-CEX, ALMAT and CBD)
Major Abdominal Surgery with general PAC Cystectomy, major colorectal surgery, Upper GI, Bariatrics and Gynae oncology with general PAC sessions WBAs as per 2010 curriculum (1x ALMAT)
Major Head and Neck Surgery with general PAC Major Maxillofacial, ENT and Plastic reconstructive head and neck procedures with general PAC sessions WBAs as per 2010 curriculum (1x A-CEX, ALMAT, DOPS)
Option block This may involve academic/research endeavours, but could be spent visiting the Cardiology or Respiratory departments.  It is assumed that most candidates will complete the CPX international course (or equivalent) in this time. WBAs as per 2010 curriculum if further clinical attachment undertaken.

The clinical expectation on which competence will be assessed is that the trainee will complete a minimum of 10 sessions in each subspecialty module of clinical work, allowing a minimum of 10 sessions per 3 months to be spent in peri-operative medicine/pre-assessment activities such as clinic.

Research opportunities


The department has an expanding research base with several exciting trials. These trials encompass research in anaesthesia, critical care and Obstetrics. Recent studies include assessing the benefits of preoperative exercise training prior to major vascular surgery. Other examples include trauma research with the Ministry of Defence and cutting-edge studies involving pre-operative assessment and cardiopulmonary exercise testing. The research team comprises a number of research active consultants, 1 academic foundation programme doctor, a critical care research fellow and 2.3 FTE research nurses. We also have accessible OAA/AAGBI money available to work with our Professor in Obstetric anaesthesia in developing critical care services for the Maternity Unit.

Previous ‘research fellowship’ positions have demonstrated an excellent track record facilitating several international/national presentations (8 prize winners) and peer-reviewed publications over the last 8 years.  Successful individuals will have a fantastic opportunity to be involved with on-going projects in addition to developing research ideas of their own.

Other opportunities include:

The trainees will be given an Educational Supervisor who has an interest in both Clinical work and pre-assessment to maximise the potential of this placement.

It is anticipated that these positions will be circulated through the Northern School of Anaesthesia. Date for interviews will be set following an agreed closing date with the Northern School.